Provider Demographics
NPI:1780331876
Name:COLBERT CLINICAL RESOURCES PLLC
Entity type:Organization
Organization Name:COLBERT CLINICAL RESOURCES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-873-6371
Mailing Address - Street 1:40315 MICHIGAN AVE # 1042
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2908
Mailing Address - Country:US
Mailing Address - Phone:248-873-6371
Mailing Address - Fax:
Practice Address - Street 1:40315 MICHIGAN AVE # 1042
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2908
Practice Address - Country:US
Practice Address - Phone:248-873-6371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty